What's the best way to get rid of acne scars?

Acne scars can be a very troubling problem. Even though the acne breakouts may be controlled or have long since stopped, the scarring remains for a lifetime.

Treatment for acne can be as troublesome as the disease itself. Usually, successful treatment requires a team approach with a dermatologist and a cosmetic surgeon.

First, attention must be turned to stopping any outbreaks, then repair of the scarring. If outbreaks continue, scarring is likely to continue, and any treatments aimed at treating scarring would be futile. There are many options for treatment of acne today depending on the severity of outbreaks. These are beyond the scope of this article, except to say that treatment for the underlying disease process is a must. Once the outbreaks are well controlled, attention can be turned toward erasing the lasting marks on the face.

Of note, acne is not only a disease of adolescence. Adult onset acne is not completely uncommon and is seen in women who are pregnant – often with more severe scarring. Treatment options for acne scars depend on the severity of the scarring and the skin type of the person wishing repair.

In people with darker skin, Fitzpatrick Types V, VI; options are limited because of concern for pigment irregularities after treatment. For lighter skinned individuals, treatments range from simple facial exfoliation to deep chemical or laser peels to surgical intervention.

For light scarring after acne, attention is placed on skin resurfacing. By taking off the outer layers of skin and stimulating collagen synthesis with new skin formation, acne scars can be reduced. This is best simulated by placing a finger on either side of an area of scarring and lightly pulling. If the scars fade, this can be a good option for resurfacing.

For deeper scars, a deep chemical peel, ablative laser (CO2 or erbium) resurfacing, or dermabrasion/dermasanding may be necessary. For deeper scars, deeper solutions are necessary. Again, several options exist.

• Deeper scars can be surgically excised with the larger acne scar replaced with a surgically placed small line. This can later be refined with other rejuvenation techniques.
• Punch grafting affords a simple method for treating multiple scars. A circular punch is used to create an incision around an acne scar. The scar is then allowed to heal and the resulting skin irregularity is smoothed.
• Subcision involves releasing the tethering attachments underneath the scar and then filling the space with either a temporary or permanent filler to prevent the scar from reforming when it heals. With the advent of new temporary artificial fillers such as hyaluronic acid, this is a good option for larger depressed scars.

Whatever the treatment option, it is important to consult a physician with a large arsenal of treatment options – if a physician only sells a cheeseburger, then you get sold a cheeseburger, even if you need a bacon burger. It is also important to remember that just as acne scars did not form overnight, treatment can sometimes take months to get the desired result. Once you find an experienced physician and decide on a treatment option, remember that it’s a long road but one that is usually worth the wait.

Based on my experience, acne scars can be greatly minimized, but are impossible to completely clear, even with deep laser peels. The deeper the scar (like ice pick scars), the more difficult it is to treat. Combination therapy seems to work best.

For mild acne scars, we tend use chemical peels, light erbium peels or 1064 q switch laser treatments. It will often take a series of these treatments to get optimal results.

It is important to make sure that active acne is treated, and several of these treatments have the added advantage of helping to reduce acne breakouts.

For moderate scars we use moderate depth erbium laser peels. It may take 2-3 peels over 9-12 months for optimal results. Using various parameters, we can resurface the scars and stimulate collagen, thus filling the depressed defects.

Severe acne scars are treated with papillary dermal erbium peels. These are rather deep peels, done in the office with both topical anesthetic and selected nerve blocks on the face. Healing time is 7-10 days.

As always, with any of these treatments, a good retinol based skin care regimen is required for long term maintenance.

Acne scars can be treated with many different techniques.

• Bridge Therapy combining ActiveFX plus DeepFX is a great way to decrease acne scars.
• Thermage can have an effect on acne scars as well.
• Both procedures can be combined on the same day if desired.
• Other lasers and devices can be used, but I have found the above combination to be the most effective. They can each be performed in a single session. Most other lasers need to be repeated a series of times to even begin to see adequate results.
• Fillers can be added where needed.

While there is no way to make one’s skin that of a porcelain doll, acne scars can be improved. This usually requires a number of treatments with the CoolTouch, Smooth Beam, Affirm, Active FX or Fraxel lasers, which can minimize their appearance.

We often combine lasers with subcision and/or injection of fillers.